Surgical Knot Tying Chapter8 P61-65

Question 1

KNOTS AND EARS
What is the basic surgical knot?
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Answer 1

Square knot

Question 2

What is the first knot that should be mastered?

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Answer 2

Instrument knot

Question 3

What is a “surgeon’s knot”?

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Answer 3

Double-wrap throw followed by single square knot throws

Question 4

How many (correct) throws are necessary to ensure that
your knots do not slip?
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Answer 4

As many as the attending surgeon wants

Question 5

What are the guidelines for the number of minimal throws needed?
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Answer 5

Depends on the suture material
Silk—3
Gut—4
Vicryl®, Dexon®, other braided synthetics—4
Nylon, polyester, polypropylene, PDS, Maxon—6

Question 6

How long should the ears of the knot be cut?

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Answer 6

Some guidelines are:
   Silk vessel ties—1 to 2 mm
   Abdominal fascia closure—5 mm
   Skin sutures, drain sutures—5 to 10 mm (makes them
       easier to find and remove)

Question 7

When should skin sutures be removed?

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Answer 7

• As soon as the wound has healed enough to withstand expected mechanical trauma
• Any stitch left in more than 10 days will leave a scar
• Guidelines are:
  Face—3 to 5 days
  Extremities—10 days
  Joints—10–14 days
  Back—14 days
  Abdomen—7 days

Question 8

How can strength be added to an incision during and after suture removal?
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Answer 8

With Steri-Strips®

Question 9

In general, in which group of patients should skin sutures be left in longer than normal?
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Answer 9

Patients on steroids

Question 10

How should the sutures be cut?

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Answer 10

• Use the tips of the scissors to avoid cutting other tissues
• Try to remove the cut ends (less foreign material
  decreases risk of infection)
• Rest the scissor-hand on the non–scissorhand to steady

Question 11

How is an instrument knot tied?

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Answer 11

Always start with a double wrap, known as a “surgeon’s knot,” and then use a single wrap, pulling the suture in
the opposite directions after every “throw”

Question 12

Does a student need to know a one-hand tie?

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Answer 12

No! Master the two-hand tie and the instrument tie

Question 13

INSTRUMENT TIE

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Answer 13

see pictures

Question 14

TWO-HAND TIE
1. What is the basic position for the two-hand tie?
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Answer 14

“C” position, formed by the thumb and index finger; the suture will alternate over the thumb and then the index finger for each throw

Question 15

2. How is a two-hand knot tied?

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Answer 15

First, use the index finger to lead: see pictures

Then use thumb to lead: see pictures

• Ask a resident or intern to help you after you have tried for a while.
• Open book to this page for guidance.
• Place the Surgical Recall bookmark at back of book to use as a suture anchor.